31 to 45 of 50
Description 30% Prepares daily and/or monthly account reconciliations of a complex nature. Ensures work conforms to all contract/business regulations and/or instructions as well as generally accepted accounting principles, federal acquisition regulations, cost accounting standards and/or departmental policies. 30% Reviews, analyzes, and/or verifies complex accounting and/or system transactions. I
Posted 15 days ago
Responsible for the most complex activities associated with maintaining ledger accounts and/or for developing financial statements and/or reports. Analyzes complex financial data and/or reports on the results and/or probable implications. Compiles financial information, processes journal entries into various accounts, and/or reconciles reports and/or financial data. Description 20% Exercises acc
Posted 15 days ago
Provides education to medical providers as warranted. Description 25% Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. 20% Conducts formal conference calls and/or in person
Posted 16 days ago
BlueCross BlueShield of South Carolina
- Baltimore, MD / Philadelphia, PA / Wilmington, DE / 2 more...
Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two states to regions with as many as ten states. Customarily and regularly engaged in outside sales. Description 25% Leads, markets, recruits, and motivates general agents, brokers, and ot
Posted 16 days ago
Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two states to regions with as many as ten states. Customarily and regularly engaged in outside sales. Description 25% Leads, markets, recruits, and motivates general agents, brokers, and ot
Posted 16 days ago
Responsible for the management and daily operations of the technical staff responsible for devising logical, automated statistical analysis programs and procedures. Description 30% Manages the activities of research and analysis staff responsible for complex statistical analysis programming and sophisticated data interpretation to support customer requirements. 20% Maintains effective communicat
Posted 17 days ago
The incumbent is expected to successfully complete the course curriculum for BlueCross' IT Entry Level Training Program (ELTP). Classroom training will focus on web/application development, system support, infrastructure or IT risk and compliance. On call will be required for some positions. Positions require a security clearance, which requires US citizenship to obtain. Description 50% Partici
Posted 17 days ago
Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high touch concierge case management for members identified into specialized programs such as high risk maternity, NICU, ESRD, Palliative Care Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure.
Posted 17 days ago
Provides reinsurance support for new and renewal business, underwriting, claims audit/record keeping and/or other functions. May perform calculations and process general accounting requests for billing or payments, and/or check the status of claims and process policy changes. Provides customer service to clients and partners. Runs reports as needed. This position is located onsite. Description 5
Posted 17 days ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk in inquiries. Accurately documents inquiries. 15% Initiates or processes adjustments or performs other research as needed t
Posted 17 days ago
Manages and coordinates the development of new business as needed to grow revenue for the company within identified markets and solutions. Identifies, pursues, and wins new business. Develops and recommends account plan and marketing approaches, and related changes as needed to reach sales goals and objectives. Prospects and develops leads leading to requests for proposals (RFP's) and sole source
Posted 17 days ago
Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities. Description 70% Manages the medical review process. Maintains a well trained staff. Develops/implements medical review strategy wit
Posted 20 days ago
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non covered services and reduce the claims payment error rate. The error rate is a factor in awarding and renewing Medicare/other contracts. This position is apart of the MolDX Program by Palmetto GB
Posted 22 days ago
Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate levels of healthcare services are provided. Description 60% Manages day to day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions. 20% S
Posted 22 days ago
Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description Ensures effective customer relations by responding accurately, timely and courteously to telephone inquiries. Accurately documents inquiries. Initiates minor /clerical adjustments based on provider request or processes adjustments or performs other
Posted 24 days ago
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